Basic Information
| Provider Information | |||||||||
| NPI: | 1861962748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATANE | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7807 41ST AVE | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113731147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183343946 | ||||||||
| FaxNumber: | 7183341903 | ||||||||
| Practice Location | |||||||||
| Address1: | 7807 41ST AVE | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113731147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183343946 | ||||||||
| FaxNumber: | 7183341903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2018 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 104631 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.